From Tragic Choices, Calabresi and Bobbitt, 1978
“We cannot know why the world suffers. But we can
know how the world decides that suffering shall come to
some persons and not to others. … For it is in the choosing
that enduring societies preserve or destroy those values
that suffering and necessity expose.” (p 17)
“It is honesty which allows us to see clearly … the ways,
some subtle and some not honest, by which societies must
cope. We want to live, but we cannot. We want men to be
equal, but they are not. We want suffering to end, but it
will not. Honesty permits us to know what is to be
accepted and, accepting, to reclaim our humanity and
struggle against indignity.” (p 26)
The all-time, bar-none, best quote ever about decision theory:
“It is not our abilities that show what
we truly are– it is our choices”
--Albus Dumbledore
Ultra-conservative Assumptions about Risk Come Naturally
“We have every reason to assume the worst, and we
have an urgent duty to prevent the worst from occurring”
-President Bush, 2002
“Even if there was even a 1 in 10 chance that
Saddam Hussein was behind the 9/11 attack
maximum priority should be placed on eliminating that threat”
- Paul Wolfowitz, 2001
Not a trick question: “What do you call a well-conducted
epidemiologic study where the best estimate of the odds
ratio is 3.0 and there is a 94% chance that the OR > 1 ??”
Choose the “Expected Value”–
Or Can You Think of a Worse Idea?
A Colossal Non Sequitur:
“The EPA has considered [the NAS recommendation]
but has decided not to adopt a quantitative default
factor for human differences in susceptibility [to
cancer] when a linear extrapolation is used. In general,
the EPA believes that the linear extrapolation is
sufficiently conservative to protect public health.
Linear approaches from animal data are consistent with
linear extrapolation on the same agents from human
data (Goodman and Wilson, 1991; Hoel and Portier,
1994)”
-- EPA Proposed Guidelines for
Carcinogen Risk Assessment (1996)
tobacco smoke
saccharin
nickel
cadmium
PCBs
asbestos
arsenic
estrogens
reserpine
ALL Estimates are “Biased”
Estimate
Corresponding Value Judgment
(Airplane ex.) (Unc. in risk)
(Var. in risk)
Mode
Max. probability Max. probability Protect “most
of arriving just
that risk is exact- common person”
as plane leaves
ly “acceptable”
Median
50/50 chance of
catching or
missing flight
Mean
X minutes late
X units “overProtect
and X minutes
spending” = X
population on
early equally bad “underspending” average
95th
X min. late = 19 X units “undertimes worse than spending” = 19
X min. early
times worse than
converse
%ile
50/50 intervention is too
risky/ too costly
Protect “typical
person”
Protect persons
at increased
exposure +/or
susceptibility
These are BOTH Policy Statements:
“Which Side Are You On?”
• “Policy makers should
base their decisions
about most health
risks on the expected
value of the risk, not
the upper bound”
-Nichols and Zeckhauser, 1986
• “Verily I say unto you,
inasmuch as ye have
done it unto one of the
least of these my
brethren, ye have done it
unto me … Inasmuch as
ye did it not to one of the
least of these, ye did it
not to me”
-Matthew 25: 40, 43